{"id":5849,"date":"2026-07-23T08:47:51","date_gmt":"2026-07-23T08:47:51","guid":{"rendered":"https:\/\/csaude.org.mz\/?p=5849"},"modified":"2026-07-23T10:10:27","modified_gmt":"2026-07-23T10:10:27","slug":"listening-is-also-intervening-lessons-from-mopeia-on-adherence-to-health-services","status":"publish","type":"post","link":"https:\/\/csaude.org.mz\/pt\/2026\/07\/23\/listening-is-also-intervening-lessons-from-mopeia-on-adherence-to-health-services\/","title":{"rendered":"Ouvir tamb\u00e9m \u00e9 intervir: as li\u00e7\u00f5es de Mopeia sobre ades\u00e3o aos servi\u00e7os de sa\u00fade"},"content":{"rendered":"
\"\"
Fotografia: Solina Ribeiro<\/figcaption><\/figure>\n\n\n\n

Quando uma mulher chega tarde \u00e0 primeira Consulta Pr\u00e9-Natal (CPN), quando algu\u00e9m recusa prevenir o HIV aderindo \u00e0 profilaxia pr\u00e9-exposi\u00e7\u00e3o (PrEP) ou abandona o Tratamento Antirretroviral (TARV) do HIV, os indicadores registam uma fraca ades\u00e3o aos servi\u00e7os de sa\u00fade. Estas formula\u00e7\u00f5es s\u00e3o fundamentais para monitorizar a qualidade dos servi\u00e7os prestados, mas escondem uma pergunta essencial que nem sempre \u00e9 colocada \u00e0s pr\u00f3prias comunidades: porqu\u00ea?<\/p>\n\n\n\n

Foi precisamente essa pergunta que levou a C-Sa\u00fade, em coordena\u00e7\u00e3o com os Servi\u00e7os Distritais de Sa\u00fade, Mulher e Ac\u00e7\u00e3o Social (SDSMAS) de Mopeia, \u00e0s comunidades de Dande, Malulo e Marruma, na prov\u00edncia da Zamb\u00e9zia, entre os dias 8 e 12 de Junho. Durante cinco dias de actividades de ausculta\u00e7\u00e3o, mobiliza\u00e7\u00e3o e sensibiliza\u00e7\u00e3o comunit\u00e1ria, mais de 230 pessoas - entre membros da comunidade, l\u00edderes comunit\u00e1rios e religiosos, membros dos Comit\u00e9s de Sa\u00fade, Agentes Polivalentes de Sa\u00fade (APS) e representantes de institui\u00e7\u00f5es locais - reuniram-se para conversar sobre sa\u00fade materna e resposta ao HIV.<\/p>\n\n\n\n

O que aconteceu em Mopeia reflecte um princ\u00edpio amplamente sustentado por evid\u00eancias cient\u00edficas: ouvir as comunidades n\u00e3o \u00e9 apenas uma etapa que antecede a interven\u00e7\u00e3o. \u00c9, em si, uma forma de intervir.<\/p>\n\n\n\n

O di\u00e1logo como ponto de partida para a mudan\u00e7a<\/strong><\/h4>\n\n\n\n

Desde a Declara\u00e7\u00e3o de Alma-Ata (1978), a Organiza\u00e7\u00e3o Mundial da Sa\u00fade reconhece o envolvimento comunit\u00e1rio como um componente essencial dos cuidados de sa\u00fade prim\u00e1rios. Este princ\u00edpio ganhou novo impulso em 2024, quando os Estados-membros da Assembleia Mundial da Sa\u00fade adoptaram a Resolu\u00e7\u00e3o WHA77.2, comprometendo-se a refor\u00e7ar o envolvimento social e a participa\u00e7\u00e3o activa das comunidades nas decis\u00f5es que afectam a sua sa\u00fade.<\/p>\n\n\n\n

No entanto, a concretiza\u00e7\u00e3o desse compromisso global continua a representar um desafio. Uma an\u00e1lise recente de 102 minist\u00e9rios da sa\u00fade de pa\u00edses de rendimento baixo e m\u00e9dio (Cocoman et al., 2025), entre os quais Mo\u00e7ambique, revelou que a participa\u00e7\u00e3o comunit\u00e1ria, quando existe, tende a concentrar-se nas fases de planeamento, sendo muito menos frequente na implementa\u00e7\u00e3o e na monitoria dos servi\u00e7os de sa\u00fade materna e neonatal.<\/p>\n\n\n\n

A investiga\u00e7\u00e3o em comunica\u00e7\u00e3o para a mudan\u00e7a social e comportamental aponta na mesma direc\u00e7\u00e3o. Durante muito tempo, muitos programas de sa\u00fade assentaram (e continuam, em muitos contextos, a assentar) num modelo de transmiss\u00e3o vertical da informa\u00e7\u00e3o: os servi\u00e7os e os especialistas det\u00eam o conhecimento e o poder de decis\u00e3o; \u00e0s comunidades cabe receber as mensagens e adoptar os comportamentos recomendados. D\u00e9cadas de investiga\u00e7\u00e3o mostram, por\u00e9m, que a informa\u00e7\u00e3o, por si s\u00f3, raramente \u00e9 suficiente para transformar comportamentos.<\/p>\n\n\n\n

A mudan\u00e7a torna-se mais prov\u00e1vel quando a comunica\u00e7\u00e3o \u00e9 dial\u00f3gica: quando as pessoas disp\u00f5em de espa\u00e7o para expressar d\u00favidas, confrontar percep\u00e7\u00f5es e normas sociais, discutir experi\u00eancias e chegar \u00e0s suas pr\u00f3prias conclus\u00f5es. \u00c9 a l\u00f3gica, inspirada no pensamento de Paulo Freire, de construir sa\u00fade com as comunidades, e n\u00e3o apenas para elas. with<\/em> communities, and not merely for<\/em> them.<\/p>\n\n\n\n

Em Mopeia, as respostas vieram das pr\u00f3prias comunidades<\/strong><\/h4>\n\n\n\n

Foi precisamente isso que aconteceu em Mopeia. O objectivo das sess\u00f5es realizadas em Dande, Malulo e Marruma era compreender os factores por tr\u00e1s de indicadores que continuam a desafiar a sa\u00fade materna e a resposta ao HIV: a chegada tardia das mulheres \u00e0 primeira CPN, a reduzida participa\u00e7\u00e3o dos homens na sa\u00fade materna, a recusa da PrEP e as dificuldades na ades\u00e3o ao TARV, sobretudo entre mulheres gr\u00e1vidas e lactantes. E as respostas vieram das pr\u00f3prias comunidades.<\/p>\n\n\n\n

Em Marruma, v\u00e1rias mulheres explicaram que a dist\u00e2ncia entre as suas resid\u00eancias e a unidade sanit\u00e1ria pesa na decis\u00e3o de iniciar tardiamente a CPN. Mas, ao longo do di\u00e1logo com as equipas de sa\u00fade, as pr\u00f3prias participantes conclu\u00edram que os benef\u00edcios da consulta precoce superam os desafios da desloca\u00e7\u00e3o.<\/p>\n\n\n\n

Os homens, por sua vez, reconheceram que muitas vezes n\u00e3o acompanham as suas parceiras \u00e0quelas consultas por n\u00e3o sabem a import\u00e2ncia do seu envolvimento durante a gravidez e o per\u00edodo p\u00f3s-parto. Mas, n\u00e3o s\u00f3: normas sociais que atribuem \u00e0 mulher toda a responsabilidade pertinente \u00e0 gravidez tamb\u00e9m fazem com que os homens tenham vergonha de ser vistos em servi\u00e7os de sa\u00fade materno-infantil e serem considerados menos masculinos.<\/p>\n\n\n\n

As conversas revelaram um conjunto de barreiras \u00e0 ades\u00e3o que nem sempre s\u00e3o vis\u00edveis nos indicadores: falta de informa\u00e7\u00e3o correcta e persuasiva, normas sociais que desencorajam a participa\u00e7\u00e3o masculina, dist\u00e2ncia aos servi\u00e7os de sa\u00fade e escassez de espa\u00e7os de di\u00e1logo.<\/p>\n\n\n\n

Do di\u00e1logo \u00e0 ac\u00e7\u00e3o<\/strong><\/h4>\n\n\n\n
\n

Mais do que esclarecer d\u00favidas, os encontros comunit\u00e1rios criaram espa\u00e7o para a constru\u00e7\u00e3o conjunta de solu\u00e7\u00f5es. No final das sess\u00f5es, os l\u00edderes comunit\u00e1rios e religiosos assumiram compromissos concretos: refor\u00e7ar a sensibiliza\u00e7\u00e3o para a CPN precoce, incentivar a participa\u00e7\u00e3o masculina nas consultas, apoiar a identifica\u00e7\u00e3o e o encaminhamento de mulheres gr\u00e1vidas para os servi\u00e7os de sa\u00fade, promover a ades\u00e3o \u00e0 PrEP e ao TARV e fortalecer a liga\u00e7\u00e3o entre as comunidades e as unidades sanit\u00e1rias. Os participantes manifestaram ainda abertura para acolher futuras actividades de Aconselhamento e Testagem em Sa\u00fade (ATS).<\/p>\n\n\n\n

A interven\u00e7\u00e3o incluiu igualmente uma sess\u00e3o de trabalho com M\u00e3es Mentoras, cujo papel \u00e9 essencial para aumentar a ades\u00e3o aos servi\u00e7os pr\u00e9 e p\u00f3s-natais.<\/p>\n<\/div>

\"\"<\/figure><\/div>\n\n\n\n

O trabalho n\u00e3o termina aqui. A C-Sa\u00fade e o SDSMAS de Mopeia continuar\u00e3o a acompanhar os compromissos assumidos e a refor\u00e7ar as actividades de promo\u00e7\u00e3o da sa\u00fade nas comunidades abrangidas.<\/p>\n\n\n\n

A forte participa\u00e7\u00e3o registada, com destaque para Marruma, que reuniu mais de uma centena de participantes, confirma aquilo que a investiga\u00e7\u00e3o tem vindo a demonstrar: quando existe espa\u00e7o para participarem, as comunidades querem discutir a sua sa\u00fade, contribuir para compreender os desafios que enfrentam e fazer parte da constru\u00e7\u00e3o das solu\u00e7\u00f5es.<\/p>\n\n\n\n

Perhaps that is the main lesson from Mopeia. The indicators will continue to show who arrives late, who abandons a treatment or who declines a service. But understanding why<\/em> Talvez essa seja a principal li\u00e7\u00e3o de Mopeia. Os indicadores continuar\u00e3o a mostrar quem chega tarde, quem abandona um tratamento ou quem recusa um servi\u00e7o. Mas compreender porqu\u00ea continua a ser uma das condi\u00e7\u00f5es essenciais para encontrar respostas eficazes. Porque ouvir as comunidades n\u00e3o \u00e9 apenas recolher informa\u00e7\u00e3o: \u00e9 uma forma de construir sa\u00fade juntamente com elas.<\/p>\n\n\n\n

Nas unidades sanit\u00e1rias apoiadas pela C-Sa\u00fade no distrito de Mopeia, no final de Junho, 9109 pessoas estavam em TARV, com uma supress\u00e3o viral de 97%.<\/p>\n\n\n\n

\"\"
Fotografia: Solina Ribeiro<\/figcaption><\/figure>\n\n\n\n

<\/p>","protected":false},"excerpt":{"rendered":"

When a woman arrives late to her first Antenatal Care (ANC) consultation, when someone declines to prevent HIV by taking pre-exposure prophylaxis (PrEP), or abandons Antiretroviral Treatment (ART) for HIV, the indicators record poor adherence to health services. These formulations are essential for monitoring the quality of the services provided, but they conceal an essential question that is not always put to the communities themselves: why? It was precisely this question that led C-Sa\u00fade, in coordination with the District Services for Health, Women and Social Action (SDSMAS) of Mopeia, to the communities of Dande, Malulo and Marruma, in Zamb\u00e9zia province, between 8 and 12 June. Over five days of community listening, mobilization and awareness-raising activities, more than 230 people \u2014 including community members, community and religious leaders, members of the Health Committees, community health workers (APS) and representatives of local institutions \u2014 came together to talk about maternal health and the HIV response. What happened in Mopeia reflects a principle widely supported by scientific evidence: listening to communities is not merely a step that precedes intervention. It is, in itself, a form of intervening. Dialogue as a starting point for change Since the Alma-Ata Declaration (1978), the World Health Organization has recognized community involvement as an essential component of primary health care. This principle gained new momentum in 2024, when the Member States of the World Health Assembly adopted Resolution WHA77.2, committing to strengthening social participation and the active involvement of communities in the decisions that affect their health. However, delivering on this global commitment remains a challenge. A recent analysis of 102 health ministries in low- and middle-income countries (Cocoman et al., 2025), including Mozambique, revealed that community participation, where it exists, tends to be concentrated in the planning stages, and is far less frequent in the implementation and monitoring of maternal and newborn health services. Research in communication for social and behavior change points in the same direction. For a long time, many health programs were based (and, in many contexts, continue to be based) on a model of vertical transmission of information: services and specialists hold the knowledge and the decision-making power; communities are left to receive the messages and adopt the recommended behaviors. Decades of research show, however, that information alone is rarely enough to transform behaviors. Change becomes more likely when communication is dialogical: when people have space to express doubts, confront perceptions and social norms, discuss experiences and reach their own conclusions. It is the logic, inspired by the thinking of Paulo Freire, of building health with communities, and not merely for them. In Mopeia, the answers came from the communities themselves That is precisely what happened in Mopeia. The purpose of the sessions held in Dande, Malulo and Marruma was to understand the factors behind indicators that continue to challenge maternal health and the HIV response: women’s late arrival at their first ANC consultation, men’s limited participation in maternal health, refusal of PrEP, and difficulties in adherence to ART, particularly among pregnant and breastfeeding women. And the answers came from the communities themselves. In Marruma, several women explained that the distance between their homes and the health facility weighs on the decision to start ANC late. But, over the course of the dialogue with the health teams, the participants themselves concluded that the benefits of early consultation outweigh the challenges of the journey. Men, in turn, acknowledged that they often do not accompany their partners to these consultations because they do not know the importance of their involvement during pregnancy and the postpartum period. And not only that: social norms that place all responsibility related to pregnancy on women also make men ashamed of being seen in maternal and child health services and of being considered less masculine. The conversations revealed a set of barriers to adherence that are not always visible in the indicators: lack of accurate and persuasive information, social norms that discourage male participation, distance from health services, and a shortage of spaces for dialogue. From dialogue to action More than clarifying doubts, the community meetings created space for the joint construction of solutions. At the end of the sessions, community and religious leaders made concrete commitments: to strengthen awareness-raising for early ANC, encourage male participation in consultations, support the identification and referral of pregnant women to health services, promote adherence to PrEP and ART, and strengthen the link between communities and health facilities. Participants also expressed openness to hosting future Health Counselling and Testing (HCT) activities. The intervention also included a working session with Mentor Mothers, whose role is essential in increasing adherence to antenatal and postnatal services. The work does not end here. C-Sa\u00fade and the Mopeia SDSMAS will continue to follow up on the commitments made and to reinforce health promotion activities in the communities covered. The strong participation recorded \u2014 most notably in Marruma, which brought together more than a hundred participants \u2014 confirms what research has been demonstrating: when there is space for them to participate, communities want to discuss their health, help make sense of the challenges they face, and be part of building the solutions. Perhaps that is the main lesson from Mopeia. The indicators will continue to show who arrives late, who abandons a treatment or who declines a service. But understanding why remains one of the essential conditions for finding effective responses. Because listening to communities is not just gathering information: it is a way of building health together with them. In the health facilities supported by C-Sa\u00fade in Mopeia district, at the end of June, 9,109 people were on ART, with a viral suppression rate of 97%.<\/p>","protected":false},"author":2,"featured_media":5847,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[1],"tags":[],"class_list":["post-5849","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-noticias"],"yoast_head":"\nListening is also intervening: lessons from Mopeia on adherence to health services - C-Sa\u00fade<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/csaude.org.mz\/pt\/2026\/07\/23\/listening-is-also-intervening-lessons-from-mopeia-on-adherence-to-health-services\/\" \/>\n<meta property=\"og:locale\" content=\"pt_PT\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Listening is also intervening: lessons from Mopeia on adherence to health services - C-Sa\u00fade\" \/>\n<meta property=\"og:description\" content=\"When a woman arrives late to her first Antenatal Care (ANC) consultation, when someone declines to prevent HIV by taking pre-exposure prophylaxis (PrEP), or abandons Antiretroviral Treatment (ART) for HIV, the indicators record poor adherence to health services. These formulations are essential for monitoring the quality of the services provided, but they conceal an essential question that is not always put to the communities themselves: why? It was precisely this question that led C-Sa\u00fade, in coordination with the District Services for Health, Women and Social Action (SDSMAS) of Mopeia, to the communities of Dande, Malulo and Marruma, in Zamb\u00e9zia province, between 8 and 12 June. Over five days of community listening, mobilization and awareness-raising activities, more than 230 people \u2014 including community members, community and religious leaders, members of the Health Committees, community health workers (APS) and representatives of local institutions \u2014 came together to talk about maternal health and the HIV response. What happened in Mopeia reflects a principle widely supported by scientific evidence: listening to communities is not merely a step that precedes intervention. It is, in itself, a form of intervening. Dialogue as a starting point for change Since the Alma-Ata Declaration (1978), the World Health Organization has recognized community involvement as an essential component of primary health care. This principle gained new momentum in 2024, when the Member States of the World Health Assembly adopted Resolution WHA77.2, committing to strengthening social participation and the active involvement of communities in the decisions that affect their health. However, delivering on this global commitment remains a challenge. A recent analysis of 102 health ministries in low- and middle-income countries (Cocoman et al., 2025), including Mozambique, revealed that community participation, where it exists, tends to be concentrated in the planning stages, and is far less frequent in the implementation and monitoring of maternal and newborn health services. Research in communication for social and behavior change points in the same direction. For a long time, many health programs were based (and, in many contexts, continue to be based) on a model of vertical transmission of information: services and specialists hold the knowledge and the decision-making power; communities are left to receive the messages and adopt the recommended behaviors. Decades of research show, however, that information alone is rarely enough to transform behaviors. Change becomes more likely when communication is dialogical: when people have space to express doubts, confront perceptions and social norms, discuss experiences and reach their own conclusions. It is the logic, inspired by the thinking of Paulo Freire, of building health with communities, and not merely for them. In Mopeia, the answers came from the communities themselves That is precisely what happened in Mopeia. The purpose of the sessions held in Dande, Malulo and Marruma was to understand the factors behind indicators that continue to challenge maternal health and the HIV response: women’s late arrival at their first ANC consultation, men’s limited participation in maternal health, refusal of PrEP, and difficulties in adherence to ART, particularly among pregnant and breastfeeding women. And the answers came from the communities themselves. In Marruma, several women explained that the distance between their homes and the health facility weighs on the decision to start ANC late. But, over the course of the dialogue with the health teams, the participants themselves concluded that the benefits of early consultation outweigh the challenges of the journey. Men, in turn, acknowledged that they often do not accompany their partners to these consultations because they do not know the importance of their involvement during pregnancy and the postpartum period. And not only that: social norms that place all responsibility related to pregnancy on women also make men ashamed of being seen in maternal and child health services and of being considered less masculine. The conversations revealed a set of barriers to adherence that are not always visible in the indicators: lack of accurate and persuasive information, social norms that discourage male participation, distance from health services, and a shortage of spaces for dialogue. From dialogue to action More than clarifying doubts, the community meetings created space for the joint construction of solutions. At the end of the sessions, community and religious leaders made concrete commitments: to strengthen awareness-raising for early ANC, encourage male participation in consultations, support the identification and referral of pregnant women to health services, promote adherence to PrEP and ART, and strengthen the link between communities and health facilities. Participants also expressed openness to hosting future Health Counselling and Testing (HCT) activities. The intervention also included a working session with Mentor Mothers, whose role is essential in increasing adherence to antenatal and postnatal services. The work does not end here. C-Sa\u00fade and the Mopeia SDSMAS will continue to follow up on the commitments made and to reinforce health promotion activities in the communities covered. The strong participation recorded \u2014 most notably in Marruma, which brought together more than a hundred participants \u2014 confirms what research has been demonstrating: when there is space for them to participate, communities want to discuss their health, help make sense of the challenges they face, and be part of building the solutions. Perhaps that is the main lesson from Mopeia. The indicators will continue to show who arrives late, who abandons a treatment or who declines a service. But understanding why remains one of the essential conditions for finding effective responses. Because listening to communities is not just gathering information: it is a way of building health together with them. 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C-Sa\u00fade","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/csaude.org.mz\/pt\/2026\/07\/23\/listening-is-also-intervening-lessons-from-mopeia-on-adherence-to-health-services\/","og_locale":"pt_PT","og_type":"article","og_title":"Listening is also intervening: lessons from Mopeia on adherence to health services - C-Sa\u00fade","og_description":"When a woman arrives late to her first Antenatal Care (ANC) consultation, when someone declines to prevent HIV by taking pre-exposure prophylaxis (PrEP), or abandons Antiretroviral Treatment (ART) for HIV, the indicators record poor adherence to health services. These formulations are essential for monitoring the quality of the services provided, but they conceal an essential question that is not always put to the communities themselves: why? It was precisely this question that led C-Sa\u00fade, in coordination with the District Services for Health, Women and Social Action (SDSMAS) of Mopeia, to the communities of Dande, Malulo and Marruma, in Zamb\u00e9zia province, between 8 and 12 June. Over five days of community listening, mobilization and awareness-raising activities, more than 230 people \u2014 including community members, community and religious leaders, members of the Health Committees, community health workers (APS) and representatives of local institutions \u2014 came together to talk about maternal health and the HIV response. What happened in Mopeia reflects a principle widely supported by scientific evidence: listening to communities is not merely a step that precedes intervention. It is, in itself, a form of intervening. Dialogue as a starting point for change Since the Alma-Ata Declaration (1978), the World Health Organization has recognized community involvement as an essential component of primary health care. This principle gained new momentum in 2024, when the Member States of the World Health Assembly adopted Resolution WHA77.2, committing to strengthening social participation and the active involvement of communities in the decisions that affect their health. However, delivering on this global commitment remains a challenge. A recent analysis of 102 health ministries in low- and middle-income countries (Cocoman et al., 2025), including Mozambique, revealed that community participation, where it exists, tends to be concentrated in the planning stages, and is far less frequent in the implementation and monitoring of maternal and newborn health services. Research in communication for social and behavior change points in the same direction. For a long time, many health programs were based (and, in many contexts, continue to be based) on a model of vertical transmission of information: services and specialists hold the knowledge and the decision-making power; communities are left to receive the messages and adopt the recommended behaviors. Decades of research show, however, that information alone is rarely enough to transform behaviors. Change becomes more likely when communication is dialogical: when people have space to express doubts, confront perceptions and social norms, discuss experiences and reach their own conclusions. It is the logic, inspired by the thinking of Paulo Freire, of building health with communities, and not merely for them. In Mopeia, the answers came from the communities themselves That is precisely what happened in Mopeia. The purpose of the sessions held in Dande, Malulo and Marruma was to understand the factors behind indicators that continue to challenge maternal health and the HIV response: women’s late arrival at their first ANC consultation, men’s limited participation in maternal health, refusal of PrEP, and difficulties in adherence to ART, particularly among pregnant and breastfeeding women. And the answers came from the communities themselves. In Marruma, several women explained that the distance between their homes and the health facility weighs on the decision to start ANC late. But, over the course of the dialogue with the health teams, the participants themselves concluded that the benefits of early consultation outweigh the challenges of the journey. Men, in turn, acknowledged that they often do not accompany their partners to these consultations because they do not know the importance of their involvement during pregnancy and the postpartum period. And not only that: social norms that place all responsibility related to pregnancy on women also make men ashamed of being seen in maternal and child health services and of being considered less masculine. The conversations revealed a set of barriers to adherence that are not always visible in the indicators: lack of accurate and persuasive information, social norms that discourage male participation, distance from health services, and a shortage of spaces for dialogue. From dialogue to action More than clarifying doubts, the community meetings created space for the joint construction of solutions. At the end of the sessions, community and religious leaders made concrete commitments: to strengthen awareness-raising for early ANC, encourage male participation in consultations, support the identification and referral of pregnant women to health services, promote adherence to PrEP and ART, and strengthen the link between communities and health facilities. Participants also expressed openness to hosting future Health Counselling and Testing (HCT) activities. The intervention also included a working session with Mentor Mothers, whose role is essential in increasing adherence to antenatal and postnatal services. The work does not end here. C-Sa\u00fade and the Mopeia SDSMAS will continue to follow up on the commitments made and to reinforce health promotion activities in the communities covered. The strong participation recorded \u2014 most notably in Marruma, which brought together more than a hundred participants \u2014 confirms what research has been demonstrating: when there is space for them to participate, communities want to discuss their health, help make sense of the challenges they face, and be part of building the solutions. Perhaps that is the main lesson from Mopeia. The indicators will continue to show who arrives late, who abandons a treatment or who declines a service. 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